[The risk factors and treatment of bronchopleural fistula after pneumonectomy].
OBJECTIVE
To analyze the risk factors which influencing the development of bronchopleural fistula (BPF) in pulmonary resections for lung cancer. To clarify the preventive techniques and treatment strategies of BPF.


METHODS
Review the clinical data of 32 patients of postpneumonectomy BPF from 965 patients accepted pneumonectomy for lung cancer from May 1987 to May 2007. Univariate and multivariate analyses were performed by the logistic regression procedure to identify the significant risk factors for BPF in 965 pulmonary resections for lung cancer.


RESULTS
The prevalence of BPF was 3.3% (32/965). BPF occurred in the right main bronchial stump in 28 patients, left main bronchial stump in 4 patients. The significant risk factors for BPF formation were right pneumonectomy, preoperative irradiation, prolonged mechanical ventilation, bronchial stump more than 2 cm and hypoalbuminemia. Multivariate analysis identified right pneumonectomy, preoperative radiotherapy and hypoalbuminemia as the risk factors of BPF. Successful closure of BPF was achieved in 13 patients (40.6%). The fistula was successfully closed in 5 of 6 patients who had received biologic glues applied bronchoscopically with a fistula less than 3 mm. Pedicled omentum was successfully used for the treatment in 5 of 6 patients with a fistula more than 3 mm.


CONCLUSIONS
Right pneumonectomy, high-dose preoperative radiation therapy and hypoalbuminemia are risk factors for postpneumonectomy BPF. Biologic glues can be applied bronchoscopically to achieve endobronchial closure of the fistula less than 3 mm. Omentoplasty is useful for the fistula more than 3 mm.
Gao
Yu-Shun
YS
Department of Thoracic Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China. 1027david@sohu.com
Meng
Ping-Jun
PJ
He
Jie
J
D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors